Improving Provider Compliance With Adult Inflammatory Bowel Disease Patient Care Guidelines in the Ambulatory Setting Through the Use of Electronic Health Records
Electronic health record (EHR) systems have the ability to improve the quality of patient care, patient safety, and provide benefits to providers and clinic practices. These systems can transform quality measurement and quality improvement methods, facilitate workflow, and track patients over time to ensure that they receive guideline-recommended, evidence-based care. Simply having an EHR system, however, may not be enough to improve the quality and safety of healthcare, especially if the system is not designed to include features specific to the treatment population. A comprehensive literature review of the evidence on EHRs and the implementation of clinical guidelines was conducted. The positive outcomes in this review supports the notion that using well-designed, evidence-based clinical decision tools or checklists within the workflow of the EHR system can improve provider compliance with inflammatory bowel disease (IBD) clinical practice guidelines. Critical content to include in the IBD checklist for the adult patient in the ambulatory setting is also recommended.

Using Physiologic, Genetic, and Epigenetic Information to Provide Care to Clients Who Are Obese
The pathology of obesity is a complex process involving interactions among behavioral, environmental, immunologic, genetic, and epigenetic factors. This article gives a broad overview of obesity. The physiology of fat storage, influence of eating behaviors on obesity, and the genetic relationship between eating and food sources are discussed. Specific genes that have been associated with obesity are introduced, with information on leptin and genes such as FTO, GLUT4, and others. This synopsis of obesity expands into environmental influences and epigenetic factors. These include food selection, gut microbiota, pregnancy, and exercise. The nurse will gain specific knowledge to assist in tailoring therapies specific to clients who are working to overcome the long-term effects of this disorder

Using Physiologic, Genetic, and Epigenetic Information to Provide Care to Clients Who Are Obese
No abstract available

Aminotransferase Ratio Is a Useful Index for Hepatosteatosis in Children and Adolescents: A Cross-Sectional Observational Study
Nonalcoholic fatty liver disease (NAFLD) and childhood obesity are emerging global health issues. The aim of this study was to identify a simple predictor of NAFLD in children and adolescents. This community-based study was conducted from December 2012 to September 2013 in Taiwan and included 1,222 children between 10 and 19 years of age. After excluding alcohol consumption and hepatic-related lesions, NAFLD was diagnosed according to sonographic criteria. Potential confounding factors (including age, gender, and anthropometric and laboratory data) were tested by logistic regression analysis. The cutoff value was determined using receiver operating characteristic (ROC) curve analysis. In addition to older age, heavier weight, and wider waist, subjects with NAFLD had significantly higher blood pressure, lipid disturbances, and alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratios. The correlation between NAFLD and ALT/AST ratio remained significant even after adjusting for confounders (adjusted odds ratio [OR], 2.19; 95% confidence interval [CI], 1.24–3.87; p = .007). The risk score of having a fatty liver, based on ALT/AST ratio, was greater than 0.981 according to ROC curve analysis (sensitivity, 60.5%; specificity, 80.3%; area under the curve, 0.756; CI, 0.71–0.80; p < .001). Therefore, ALT/AST ratio may represent a powerful index of hepatosteatosis in children and adolescents.

Persistent Symptoms in People With Celiac Disease Despite Gluten-Free Diet: A Concern?
Studies show that people with celiac disease have reduced well-being and have persistent symptoms, mainly related to the gastrointestinal tract. The aim of this study was to analyze how persons in a celiac disease member association report their symptoms, health, and life satisfaction. A questionnaire, with both open and closed questions, was distributed to all members (n = 726) of a celiac association in the southeast of Sweden. The response rate was 74.5%, of which 524 (72%) said they had received a celiac disease diagnosis and were thus included in the study. Almost half of the participants (40.7%–42.2%) stated that they had persistent celiac disease symptoms despite following a gluten-free diet. Diarrhea, abdominal pain, and congestion were persistent symptoms reported and could contribute to a lower health status compared with people without persistent symptoms. The life satisfaction scale (LiSat-9) showed differences in 5 of 9 variables between the groups. Living with celiac disease is far from easy when you have persistent symptoms. People with celiac disease require follow-up by healthcare services, and a new treatment needs to be developed because following the gluten-free diet alone does not seem to alleviate symptoms in everyone.

PIGMENTED MACULES REMOVAL WITH COSMETIC TREATMENT MAY COVER UP PEUTZ–JEGHERS SYNDROME: A CASE REPORT
No abstract available

PROTON PUMP INHIBITORS FOR FUNCTIONAL DYSPEPSIA
No abstract available